Iran has the highest rate of accident casualties in highways and cities in the world, even more than terrorist attack life losses in the Middle East. More than 23,000 fatalities and 27,000 injuries are the result of car accidents annually. Motorcycles passengers and pedestrians are the main victims of these casualties. Definitely, by appropriate measures, the suffering of many of these trauma victims could be diminished. In our country, many facilities and instruments for this purpose are available, but are not used to their full potential which leads to higher traffic casualty and losses. Unfortunately, it takes between twenty minutes to five hours to transfer the accident victims to hospitals and consequently, eighty percent of them lose their life during this process. Many approaches could be used to overcome these problems such as improving highway and road qualities, educating the public regarding correct driving habits and better rescue team training. Fortunately, ATLS training classes are offered in Iran. By further expansion of these courses in different parts of the country, more victims of accident related traumas could be saved.

Dealing with life-threatening situations requires the quickest, most effective response. Each time the emergency phone number 115 is dialed, EMS is ready to act and dispatch the rescue services needed. Whether it is a fire, road accident, crime or medical crisis, the caller in distress should receive support from emergency services and lives should be saved. To be able to meet the required response times and to handle every complex situation, related studies showed that there are a lot of problems in emergency services in Iran such as: the lack of planning, Inadequate organizational management of resources, Insufficient coordination in the provision of health services in emergency and disaster, duplication efforts, wasting resources, wasting time: response time, organizational conflict, and most important different Emergency numbers with different dispatch system. This study has been done to develop integrated dispatch system between EMS, Fire brigade, Red Crescendo, Traffic Police and Road maintenance organization. This study has been done using multi method approach including, individual interview, FGD, Expert panel and reviewing international experiences. Study showed that developing PSAP: Public Service Answering Point (SOS) with integrated dispatch system can solve a lot of coordination and cooperation problem and improve the quality of care for people who needs life saving emergency services. The concept of providing emergency care for the seriously ill is one of the measures of a civilised society. Throughout the world, the emergency medical systems have been focused on the delivery of care to life-threatening emergencies. The provision of organised prioritisation and dispatching systems is the first step in the delivery of emergency medical support in the prehospital setting. Emergency medical dispatching(EMD) with a single common number can play crucial role in saving life and improving quality of care in life treating situation

One of the leading causes of death and disability in the Middle East is road traffic accidents. There are multiple factors that cause these traffic accidents, and the most important of which is fatigue, drowsiness and lack of concentration. The risk of road traffic accidents due to sleepiness, which were reported by police, increased by more than sevenfold in low alertness hours during circadian rhythm (0-6 A.M.) compared to other times during the day. The risk of road traffic accidents due to fatigue and sleepiness decreased in hours with maximum of alertness (6-10 P.M.) of circadian rhythm compared to other times during the day. Public health officials, road traffic designers and the police should co-operate in an interdisciplinary method to implement the proven effective measures to lower this increasingly heavy social and economic burden. Sleep and fatigue-related vehicle accidents are not only more common than is generally realized, but are more likely to result in death and serious injury owing to the relatively high speed of the vehicles on impact. To examine and address this public health issue, a screening program for drowsiness in commercial drivers is under development. Driver’s sleepiness due to sleep disorders are an important preventable cause of morbidity and mortality. Screening of commercial drivers is a topic of growing interest in occupational sleep medicine.

Association of citizenry is known as a major factor in order to reach developmental goal, especially urban development. As much as higher cooperation of people in their own urban developmental could be absorb, there will be higher percentage of success. Now day cooperation of people in their own urban development is a critical factor, critical to make a persistent urban development. When the people association is considered weak point and positive point, chances and threats are more necessary to be evaluated. In modern city management and in the world, which are consistently move toward urbanization, citizenry association are so important. Aim of the present study was prevention of road accident and crash through emphasizing on the active role of citizen cooperation. For this purpose, number of 30 adult citizen of a region in Pasdaran town as a voluntary group, who had taken a part in an organized program were selected and various class set for them. At the end of the programs with respect to the survey which have been done. We concluded that citizen have an active role in management of their own areas and were satisfy from the administrative process. This clearly represented that such association by enhancements of two side responsibility feeling could have significant impact and could lead to positive outcome. Finally, partnership and involvements of citizen in the process of programing could

Now day, there are an increasing number of people who lived in city, which made more usage of vehicle. However, these may have a lot of advantage but there should be a culture promotion in order to reduce road and traffic accident. Road crash have significant impact on society, culture, and economy of a nation. One of the major problems in this regards is the lack of knowledge about the importance of this matter. Road crash damage up to 6-8% of gross domestic product of a country and could destroy economy. However, based on resistive economy policy, enhancements of safety culture among nation and society could have significant correlation with sustainable development and improvement of life levels in society. Based on our studies which were done we found that road accidents are the ninth cause of human death around the world, however in the Iran it is the second cause of human death. Average ages of Victims are almost between 15 to 44 years old. Furthermore, 79 % of deaths are men. The crash of two car with each other include 48% of death and 30% of this accident mostly are due to fatigue of drivers. Human mistake which lead to road accident and crash are including: Widespread disease and effects of drug usage and addictive drugs are the most important one for diabetes, high blood pressure, somniferous drugs and etc. Psychology problems and mental disorders are the other one such as stress, aggressive driving, anger and others. Special situation of driving including driving at night or in the winter and etc and also lack of knowledge of people. Road accidents are one of the major causesof death in Iran and the important point in this regards is to establish some policy which could be as Precautionary policy. In this regard, using effective potential of our society such as social workers can make a significant difference. This will change anti-social attitude of some people who think that why I should obey all of the traffic roles. This people are thinking that I should change the social as well as traffic role and adopt them to their own Idea. Therefore, there should be some permanent education for different ages from children up to elder consist of various themes such as Safety, first aid, psychology accident in order to enhance social culture. Moreover, test of safety, precaution of accident and analyze of psychological state of drivers before giving them driver license should be done. We should also name a day of year as a national day of reduction in road accident and crash to absorb the attention of different social group to produce new idea about road safety.

Efficacy of Life Review Therapy with Emphasis on Islamic Ontology on Decreasing PTSD Symptoms

Masoumeh Esmaeily

Allameh Tabatabaee University, Tehran, Iran.

The Neuroscience Journal of Shefaye Khatam, 2015; 2(S3): P8

Life review therapy has been used for reducing post-traumatic stress disorder (PTSD) symptoms in older ages. Using life review therapy with elements of religious ontology, this study introduces an intervention for decreasing PTSD symptoms in younger adults. The study population included clients referred to the two counseling centers in Tehran during 2008 and 2009. The sample consisted of 18 clients who referred for treatment with PTSD diagnosis by their psychiatrist and were willing to participate in the study. After completion of diagnosis process and a pre-test, clients were randomly assigned to two groups of intervention and control. PTSD symptoms were assessed by PTSD questionnaire before and after the intervention. The intervention group received ten sessions of life review therapy and the control group was invited to attend treatment sessions after the study and the post-test. None of the members of the two groups took any medication during the study period and they were followed up three months later to check the persistence of the effects. Analysis of data by t-test showed a significant decrease in PTSD symptoms in the experimental group. Findings showed that life review therapy with emphasis on islamic ontology was effective in reducing PTSD symptoms. Using elements of religious ontology for those who believe with a process of life review therapy can be effective in reducing PTSD symptoms.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

The Neuroscience Journal of Shefaye Khatam, 2015; 2(S3): P9

Spinal cord injury (SCI) is a devastating condition with enormous personal and social costs. To develop preventive strategies, the determination of epidemiological features and causes is required. Due to Iran’s high incidence of road traffic crash (RTC) injuries, epidemiologic data concerning specific causes of SCI may assist in reducing this national health dilemma. In a retrospective study in Tehran hospitals, the records of traumatic SCI patients, admitted between March 2010 and July 2011 were surveyed. A total of 138 traumatic SCI patients were admitted, of which 56 (40.6%) were due to RTC that the majority of them were male (78.6%) and the mean age was 32±15 years. The most common spinal fractures/dislocations due to RTC among SCI patients were related to the thoraco-lumbar region. However, RTC was the most frequent cause of tetraplegia (cervical SCI)-(56%) and also hospital death (OR=3.2, CI=0.9-11.5). Each SCI-RTC patient paid averagely 79,000,000±56,000,000 Iranian Rials. Whereas the cervical SCI is the most frequently hospitalized SCI in the developed countries, here, most of cervical SCI patients are passed away in the scene of accident due to inadequate emergency medical services. On the other hand, based on an approved national policy, all medical services are free-of-charge for RTC victims. But the payment of above mentioned huge sums by patients could be related to law breaking in hospitals or weak law enforcement. More studies are suggested to evaluate the incidence of severe RTC injuries which lead to pre-hospital deaths were not considered in our study.

Comparing Hostility and Sleep Disorders among Nursing Students of Islamic Azad University, Toyserkan Branch with and without PTSD

Both at 11th edition of the international classification of diseases (ICD-11) and in Fifth edition of the diagnostic and statistical manual of mental disorders (Fifth edition- DSM-5), have pointed out that attitudes and quality of sleep can be seriously impaired by post-traumatic stress disorder (PTSD). The present study was conducted to compare hostility and sleep disorders among nursing students of Islamic Azad University, Toyserkan branch with and without PTSD. This descriptive-comparative causal study was performed on 190 (140 girls & 50 boys) nursing students. Participants were chosen by available sampling. They completed three scales: the post traumatic stress disorder checklist-military version (PCL- M); hostility subscale from Buss & Perry aggression questionnaire and sleep disorder subscale from Mississipi scale for combat-related post-traumatic stress disorder. Data were analyzed and processed using descriptive statistics and T test, by SPSS18. Result revealed that overall, 56 out of the 190 students identified with PTSD and they obtained significantly higher scores on hostility and sleep disorders (P<0.05). Due to considerable prevalence and impact of post-traumatic stress disorder on sleep quality and hostility patients who suffer from this disorder, it is essential that substantial interventions to diagnose and treatment of patients to be performed.

A high number of people in the world suffered from spinal cord injury (SCI). Spinal cord injuries are happen due to falls from height, accidents, climbing, sports and etc. Emergency care according to the standards not performed immediately after SCI. A significant enhancement in the number of mortality and complications was observed every year. The aim of this study is to prevent the mortality, neural injuries, hypoperfusion, ischemia, biochemical, and inflammatory changes. The first act in acute spinal cord trauma is to establish a secure airway with the fixing of the spine. Keeping the airway clear, oxygen supply, adequate ventilation, and maintain sufficient perfusion of the spinal cord must be noticed. Neurological damages may be occurred without proper fixation of the SCI. All victims of spinal cord trauma must be immobilized immediately and correctly (collar and splint and etc.). After stabilization of the airway and hemodynamic of the patient neurological status must be evaluated. Neurological injury can be distinguished from hemorrhagic shock by controlling pulse, temperature, urine output. Maintain blood pressure above 90 mmHg is necessary to prevent secondary ischemic injury. Stabilization of blood pressure is very important because low blood pressure hampers the development of microcirculation the spinal cord. While high blood pressure causes bleeding and edema (Arterial blood pressure should be 80-100 mmHg). Methylprednisolone protocol must be done after the evaluation and diagnosis of spinal cord injury. Fans rush in surgery believed that systemic effects of SCI decrease in the first 24 hours, but fans delay in surgery prefer to stable situation of neurological surgery. The results of this research revealed that promptly evaluation and management of SCI can considerably decrease the complications and mortality. Therefore, we can put treatment protocols of these patients in the emergency department and training nurses and physicians in this field.

Determation the Effectiveness of Cognitive- Behavioral Therapy in Reducing Symptoms of Post-Traumatic Stress Disorder in Victims of Road Accidents

Post-traumatic stress disorder (PTSD) is the one of the main disorders arising from disastrous experiences. Road accidents are common reasons for mental disorders which are associated with trauma. With regard to the prevalence and effects of PTSD, treatment of these disorders is very important. The aim of the present study is to determine the efficacy of cognitive-behavioral therapy in reducing symptoms of PTSD in road accidents victims. Population of this study consists of 50 subjects of road accident victims hospitalized in different wards of 3 hospitals in Esfahan city. Thirty nine subjects have earned maximum score of the PCL questionnaire and 30 subjects were randomly selected and divided into two groups as the experimental group and control group. The experimental group received eight ninety-minute sessions of cognitive-behavioral therapy and the control group did not receive any therapy program. After the end of therapy sessions, the two groups were tested and the results compared with the primary scores. Data were analyzed using spss16 software. Results showed that there are significant differences between the control and experimental groups in terms of PTSD mean (P<0.05). Based on these findings, we conclude that cognitive behavioral therapy dramatically, leads to reduce symptoms of PTSD in road accidents.

The Study of the Mistakes and Errors Made by Distracted and Undistracted Drivers in Road Safety of Users

Alireza Sadeghi Ghadi

Traffic Police Applied Research Center, Tehran, Iran.

The Neuroscience Journal of Shefaye Khatam, 2015; 2(S3): P33

Road users such as drivers, motorists, motorcycle riders, bike riders and pedestrians play an important role in traffic safety. Most accidents can be prevented by accurate and regulated driving based on the traffic laws and regulation. In fact by recognizing the errors made by violated drivers we are able to find the appropriate lawful solution for them and to avoid repeating violations made by drivers in the near future and saving the life of road users such as pedestrians and drivers. This study aims to examine the kind and nature of mistakes made by drivers when distracted and not distracted. In fact this study examined what kinds of errors made in two situations and to compare them. In this study was asked from the participants drove an equipped vehicle around an urban test route both while distracted and while not distracted. Two in –vehicle observers recorded the driving errors and mistakes made, and a range of other data such as driver verbal protocols, video and the data of vehicle (speed, brake, steering wheel angle and so on). Categorization of the errors and mistakes showed that distracted drivers (drivers being distracted by playing mp3 player, talking to mobile phone and talking to occupant seating in the car) significantly make errors although undistracted driver’s errors were prevalent. However the natures of errors made by both drivers were not significant. This study showed that in addition to making different types of errors, distracted drivers simply make a great number of the same errors type they make when not distracted. Understanding of the relationship between distraction and driving errors and mistakes are discussed along with the advantages of using a multi-framework for studying driver’s behavior. Distracted divers made 268 mistakes and errors while undistracted made 180 errors. The general estimation equations (GEE) showed that distracted drivers had 48 percent errors more than undistracted drivers. The result also showed the common mistakes of both drivers such as turning left or right fast; hit the brake inappropriately and so on.

Effectiveness of Safety Seats on Reduction of Head Injuries and Fatalities of Children in Accidents

Alireza Adibfar1, Seyed Ramtin Bagheri2, Ali Khoshbakht3

1Department of Civil Engineering, Iran University of Science and Technology, Tehran, Iran.

Children under 5 years old are the most vulnerable age group in car accidents. Researchers showed that application and correct use of child safety seats can reduce the risk of fatal injury by 71 percent for infants and 54 percent for toddlers. The purpose of this review is to identify factors and procedures that declare the correct use of child car seats which prevent children head injuries that are close to fatal ending. The information presented in this paper describes the importance of safety seats, the correct use of them referring to data which are collected in USA, Shanghai and Sweden. Children under 5 years old are potential victims of car accidents, mostly because of head crashes. Car safety seats can definitely prevent injuries and fatalities. Safety seats are designed upon age groups and the correct use of them is so important to prevent head injury and fatality.

Obesity is one of the most prevalent diet-related problems and increases the risk for diabetes mellitus, hypertension, atherosclerosis and dyslipidemia. Cardio vascular disease is a major cause of morbidity and mortality in spinal cord injury (SCI) patients. Increased fat mass has also been identified as an important risk factor in chronic SCI and weight management is recommended as a key cardio vascular disease prevention strategy. The aim of this study is to determine the prevalence of overweight and obesity in persons with spinal cord injury. An observational analytic cross sectional study on 850 files of SCI patients registered in the current database in Khatam Alanbia Hospital from 2008 to 2013 was undertaken. Data collected for each patient included age, sex, height, weight, duration of spinal cord injury and the level of spinal cord injury. The body mass index (BMI) was subsequently calculated for each patient and the prevalence of overweight and obesity were determined. 833 patients were male and 17 were female. In all, 50.2% of patients had a normal BMI and 7.6% of patients were undernourished. The prevalence of overweight and obesity were 32.1 % and 10 % of patients, respectively. Prevalence of overweight and obesity are high in persons with spinal cord injury and there is a

Trauma during pregnancy is remarkably common, motor vehicle crashes are cause of hospitalized trauma during pregnancy. Trauma occurs in 5% of pregnancies that appropriate high proportion of maternal and fetal mortality. Motor vehicle crashes, falls, assaults, including domestic violence, are all important mechanisms of injury. Motor vehicle accidents account for more than 50% of all traumas during pregnancy and 82% of fetal deaths occurring during these automobile accidents. The most common injuries seen in pregnant women, such as: blood loss, abruption placenta and the presence of disseminated intravascular coagulation was the most significant predictor of fetal mortality. Following blunt trauma, abruption of the placenta is the most common cause of fetus loss. The use of seat belts decrease rate of maternal and fetal mortality. Despite current recommendations and laws regarding seat belt use during pregnancy, one-third of pregnant women didn’t use seat belts or use improperly. In conclusion, pregnant women should be counseled to wear seatbelts throughout pregnancy to reduce motor vehicle crashes risk.